Have you received custom orthotics for treatment of plantar fasciitis
and found that they did not relieve your pain? Many people have. Recent
research on orthotics and plantar fasciitis has shown how orthotics
should be prescribed to best treat plantar fasciitis and why many
orthotics do not control plantar fasciitis pain / heel pain as well as
How Must Orthotics Be Made to Relieve Plantar Fasciitis?
Let’s first look at the cause of plantar fasciitis. In simple terms it is due to the foot flattening out too much. As can be seen in the picture on the right, when the foot flattens, the foot gets longer and this stretches the plantar fascia. This stretch is what causes the damage to the tissue and pain at the heel and arch.
In order to best control plantar fascia pain, an orthotic must work to decrease tension on the plantar fascia. To decrease tension on the plantar fascia, it must stop the foot from getting flatter and longer. To do that the orthotic must conform very close to the arch of the foot, figure 1.
Figure 1 - Tight fitting orthotic.
This is where most plantar fasciitis orthotics fail in reducing tension on the plantar fascia, they simply do not conform close enough to the arch of the foot. Take a look at figure 1 and note how close the arch conforms to the foot. Now look at figure 2 and see how the orthotic gaps from the arch. This lower arch lets the foot flatten and lengthen and increases tension on the plantar fascia. Only orthotics that conform very close to your arch are able to effectively reduce plantar fascial tension. These are called “total contact orthotics”.
Figure 2 - Loose fitting orthotic
The importance of total contact orthotics has been demonstrated in several well done studies. In particular, a 1996 study by GF Kogler tested a series of five different orthotics by placing them under cadaver feet and then applying a load to the foot, Figure 3. A strain gauge was put into the plantar fascia to measure how much tension was relieved by each type of orthotic. Kogler’s experimental apparatus is shown at right. Kogler showed definitively that orthotics that conformed closely to the arch of the foot (higher arched orthotics) best decreased tension in the plantar fascia. In fact, two of the lower arched orthotics actually increased tension in the plantar fascia.
Figure 3 - Orthotic study using strain gauges.
If you need orthotics for plantar fasciitis, you want to be absolutely sure that they are made correctly and conform almost air tight to your arch.
Keys to Making Proper Plantar Fasciitis Orthotics:
Does everyone with plantar fasciitis or heel spurs need custom
Absolutely not. But if you have had repeated episodes of plantar fasciitis, have had it for more than 6 months, have tried other treatments without success or simply have bad foot mechanics, you will probably need custom orthotics for complete and long-term relief. But if you don’t fit in these categories, you may do fine with a prefabricated orthotic and often that is what we first recommend. Like custom orthotics, prefabricated ones work best for heel pain if they have a higher arch profile. We list the best prefabricated orthotics and other home treatments for plantar fasciitis here.
Why Are So Many Plantar Fasciitis Orthotics Not Made Correctly?
Sadly, orthotic therapy is not as well regulated as it should be. Many practitioners who provide orthotics are not well trained in orthotic therapy and many who were once well trained have not kept abreast of the latest research.
Why do Custom Orthotics Work Better than OTC Arch Supports for Plantar Fasciitis?
Many patients with heel pain respond well to OTC orthotics. They are often an inexpensive way to start treatment. In fact, we often recommend over-the-counter plantar fasciitis arch supports for treatment of heel pain. OTC, however, will not work as well as custom orthotics (if the custom ones are made correctly) at decreasing tension on the plantar fascia because they do not conform as close to the arch of the foot.
What are the Best OTC Plantar Fasciitis Arch Supports?
The biomechanics are the same whether using custom orthotics or OTC arch supports to treat plantar fasciitis. So when we recommend arch supports for heel pain patients, we look for insoles that have a higher arch that will best decrease tension on the plantar fascia. The best we have found is the Powerstep Medical Grade Arch Support for plantar fasciitis. We recommend this model over others due to the relatively high arch and the overall stability. We also find it easy to adjust. After reviewing many arch supports, we find this the best arch support for plantar fasciitis.
1. Bordelon RL: Subcalcaneal pain. Clin Orthop 177:49, 1983
2. Capon, N, Higgs, ER, Dieppe, PA, et al: Arthritis in Behcet’s syndrome. Br J Radiol 56:87,1983
3. Cheung JT et al: Effect of Achilles tendon loading on plantar fascia tension in the standing foot. Clinical Biomechanics (Bristol, Avon) 21(2):194-203, 2006
4. Digiovanni BF, et al: Plantar fascia specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up: J Bone Joint Surg 88A:1775-81, 2006
5. Harty J: The role of hamstring tightness in plantar fasciitis: Foot Ankle Int 26(12) 1089-92, 2005
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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
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